title: Substance use disorders and racial/ethnic minorities matter: a meta-analytic examination of the relation between alliance and outcome.
abstract: The purpose of this meta analysis was to examine the moderating impact of substance use disorder as inclusion/exclusion criterion as well as the percentage of racial/ethnic minorities on the strength of the alliance-outcome relationship in psychotherapy. It was hypothesized that the presence of a Diagnostic and Statistical Manual of Mental Disorders (DSM) Axis I substance use disorder as a criterion and the presence of racial/ethnic minorities as a sociocultural indicator are moderately correlated client factors reducing the relationship between alliance and outcome. A random effects restricted maximum-likelihood estimator was used for omnibus and moderator models (k = 94). The presence of (a) substance use disorder and (b) racial/ethnic minorities (overall and specific to African Americans) partially moderated the alliance-outcome correlation. The percentage of substance use disorders and racial/ethnic minority status was unexpectedly highly correlated in the present treatment research samples. Sociocultural contextual variables should be considered along with a DSM Axis I diagnosis of substance use disorders in analyzing and interpreting therapy process variables such as the alliance.
authors.affiliation: Department of Psychology, University of Zürich.
authors.forename: Christoph
authors.initials: C
authors.lastname: Flückiger
authors.forename: Aaron C
authors.initials: AC
authors.lastname: Del Re
authors.forename: Adam O
authors.initials: AO
authors.lastname: Horvath
authors.forename: Dianne
authors.initials: D
authors.lastname: Symonds
authors.forename: Michael
authors.initials: M
authors.lastname: Ackert
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Wampold
mesh_terms: D005006:Ethnicity / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D008913:Minority Groups / Q000523:psychology* / Q000706:statistics & numerical data; D011369:Professional-Patient Relations; D011613:Psychotherapy / Q000379:methods*; D019966:Substance-Related Disorders / Q000523:psychology* / Q000628:therapy*; D016896:Treatment Outcome